AIPGMEE 2009 Rapid Review cover

Contents

Anatomy

  1. Artery in anatomical snuff-box is radial artery.

  2. Superior gluteal nerve supplies gluteus minimus, tensor fascia lata and gluteus medius.

  3. Flexor digitorum profundus, pectineus and biceps femoris are composite muscles.

  4. Branches of splenic arteries includes short gastric artery, hilar branches and arteria pancreatica magna.

  5. Content of deep perineal pouch includes dorsal nerve of penis, bulbourethral gland and sphincter urethrae.

  6. Urogenital diaphragm is made up of deep transverse perineal, perineal membrane and sphincter urethrae.

  7. Lymphatics from spongy urethra drain into deep inguinal nodes.

  8. Middle superior alveolar nerve is a branch of Maxillary nerve.

  9. Parasympathetic secretomotor fibers to parotid traverse though otic ganglion, tympanic plexus and aurico temporal nerve.

  10. Trochlear nerve has longest intracranial course, it is only cranial nerve that arises from dorsal aspect of brainstem and it enters orbit through superior orbital fissure outside the annulus of Zinn.

  11. Area that lies immediately lateral to anterior perforating substance is Limen insulae.

  12. Medulla oblongata is supplied by anterior spinal artery, basilar artery and posterior inferior cerebellar artery.

  13. Choroid plexus is insensitive to pain.

  14. Sternberg canal is located anterior and medial to Foramen rotundum, represents persistent craniopharyngeal canal and cause of intra sphenoidal meningocele.

  15. Closure of neural tube begins at cervical region.

  16. Chief cells are located and most abundant at Fundus of gastric gland.

  17. Paneth cells are rich in rough endoplasmic reticulum, rich in zinc and contains lysozyme.

  18. Gut associated lymphoid tissue (GALT) is primarily located in Lamina propria.

Physiology

  1. Oxygen-hemoglobin dissociation curve is sigmoid because binding of one oxygen molecule increases the affinity of binding other O2 molecules.

  2. An increase in concentration of 2-3 biphosphoglycerate may be seen in anemia, hypoxia and isosine.

  3. Central chemoreceptors are most sensitive to increase in PCO2 in blood.

  4. Primary direct stimulus for excitation of central chemoreceptors is increase in H+.

  5. During diastole, atrial pressure is maintained by elastic recoil of aorta.

  6. Vasomotor center (VMC) acts along with cardiovagal centre (CVC) to maintain blood pressure.

  7. Myocardial oxygen demand correlates with heart rate.

  8. Cyanosis does not occur in severe anemia because critical concentration of Hb required to produce cyanosis is reduced.

  9. Factor XII, XI and IX are involved in intrinsic pathway.

  10. Factor XIII helps in bridging fibrin in a clot and stabilizes the clot.

  11. When a person changes position from standing to lying down, venous return to heart increases immediately.

  12. Main cause of increased blood flow to exercising muscles is vasodilation due to local metabolites.

  13. Distal renal tubules always receives hypoosmotic solution.

  14. GFR is controlled by resistance in afferent and efferent arterioles.

  15. Glomerulus receives capillaries from the afferent arterioles.

  16. Angiotensin II stimulation of thirst, increased ADH secretion and aldosterone secretion.

  17. Intrinsic factor of Castle is secreted by Enterochromaffin cells.

  18. Sertoli cells play key role in spermatogenesis.

  19. Action potential is initiated at the Axon Hillock – initial segment of neuron because threshold for excitation is lowest there.

  20. Transmission of regulatory signal through the ECF by synaptic signal through neurotransmitters, endocrine signals through hormones and G protein coupled receptors.

  21. Cutaneous shunt vessels have a role in thermoregulation.

  22. Appetite is stimulated by Agouti related peptide (AGRP), melanin concentrating hormone (MCH) and Neuropeptide Y.

  23. Key regulators of sleep are located in Hypothalamus.

Biochemistry

  1. Enzymes involved in oxidation-reduction reactions includes dehydrogenases, oxygenases and peroxidases.

  2. Methyl side chain is least polar.

  3. Facilitated diffusion required a carrier protein.

  4. After overnight fasting, levels of glucose transporters are reduced in Adipocytes.

  5. Acetyl CoA can be converted into fatty acids, cholesterol and ketone bodies.

  6. Lipoprotein lipase are found in adipose tissue and myocytes and its deficiency leads to hypertriacylglycerolemia.

  7. Gaps between segments of DNA on the lagging strand produced by restriction enzymes are rejoined/ scaled by DNA ligase.

  8. Normal role of MicroRNA is Gene regulation.

  9. Splicing activity is a function of snRNA.

  10. CAP in Lac operon is an example of positive regulator.

  11. In sickle cell disease FLP results from a single base change, ‘sticky patch’ is generated as a result of replacement of a non-polar residue with a polar residue and HbS confers resistance against malaria in heterozygotes.

  12. Sickling in HbS is primarily caused by decreased solubility.

  13. Energy expenditure in resting state depends on Lean body mass.

  14. Recommended dietary allowances (RDA) is statistically defined as two standard deviations (SD) above estimated average requirement (EAR).

  15. Plant component Lignin is not fermented by gastrointestinal microorganisms.

  16. 10-year-old with aggressive behaviour, poor concentration, presenting complaints being joint pain, reduced urinary output, h/o self-mutilating behaviour stating that he tends to mutilate his fingers. Likely enzyme deficiency is HGPRTase.

  17. Lambda phage in lysogenic phase fuses with host chromosome and remains dormant, it lytic phase it fuses with host chromosome and replicates and in lytic phase it causes cell lysis and released virus particles.

  18. Initiation of visual impulse is associated with photoisomerization and hydrolysis of visual purple.

  19. Protein with molecular weight of kD is subjected to SDS PAGE electrophoresis which show widely separated bands of 20 kDA and 30 kDA after addition of Mercaptoethanol. The Protein is a dimer of two 20 kDA and 30 kD proteins.

Pharmacology

  1. Use of Tamoxifen for breast cancer can cause Thromboembolism, endometrial carcinoma and cataract.

  2. Effects of estrogen includes reduced LDL and increase in Triglycerides.

  3. Adverse effects of valproic acid derivatives includes Alopecia, Liver failure and weight gain.

  4. Nitroglycerine causes methemoglobinemia, hypotension, tachycardia and vasodilation.

  5. Cefoperazone does not need dose modifications even in presence of raised levels of GFR.

  6. Alcohol, sulfasalazine and phenytoin precipitates folate deficiency.

  7. Drugs which precipitate Tacrolimus toxicity includes gentamicin, Cisplatin and Vancomycin.

  8. Side effects of tacrolimus include nephrotoxicity, neurotoxicity and hepatotoxicity.

  9. Ifosfamide is an Alkylating agent.

  10. Bleomycin is cell cycle phase specific anti-cancer agent.

  11. Bleomycin toxicity is characterised by Hyperplasia of Type II pneumocytes.

  12. ‘Hand foot’ syndrome can be caused by Capecitabine.

  13. Drugs used in acute angle closure glaucoma includes Pilocarpine, Clozapine and Duloxetine.

  14. Treatment of choice for severe falciparum malaria is Intravenous artesunate.

Pathology

  1. Most characteristic feature of acute inflammation is vasodilatation and increased vascular permeability.

  2. Most effective bactericidal system within phagocytes is reactive oxygen metabolite mediated.

  3. Mitochondria plays a pivotal role in Apoptosis.

  4. Primary structural defect of an organ is termed as Malformation.

  5. Increased cross linkage in collagen, increased accumulation of free radicals and accumulated mutations in somatic cells are associated with increased aging.

  6. 45-year-old man with severe chest pain was diagnosed of acute MI. 4 days later he died and autopsy showed transmural coagulative necrosis. Microscopic feature seen will be Neutrophilic infiltration surrounding coagulative necrosis.

  7. Finnish type of congenital nephrotic syndrome occurs due to gene mutations in Nephrin.

  8. Microscopic polyangiitis is associated with pauci-immune crescentic glomerulonephritis.

  9. Paraneoplastic syndrome associated with RCC includes polycythemia, hypercalcemia, hypertension and cushing syndrome.

  10. Commonest histological finding in benign hypertension is Hyaline arteriosclerosis.

  11. In xanthogranulomatous pyelonephritis foam cells, yellow nodules and giant cells are seen.

  12. Coombs positive hemolytic anemia is associated with SLE, Scleroderma and PAN.

  13. Hypersensitivity pneumonitis is classically described as a Type III (immune complex) hypersensitivity.

  14. Psammoma bodies may be seen in papillary carcinoma of thyroid, Meningioma and Serous cystadenocarcinoma of ovary.

  15. In Hashimoto’s thyroiditis has follicular destruction, increase in lymphocytes and oncocytic metaplasia.

  16. CD117 is specific for gastrointestinal stromal tumours (GIST).

  17. Rate of newly synthesized osteoid mineralization can be best estimated by Tetracycline labeling.

  18. Karyotyping is useful in diagnosis of Chromosomal abnormalities.

  19. When a functional gene is inherited from one parent only, the condition is known as Genomic imprinting.

Microbiology

  1. Hypochlorites are bactericidal and inactivated by organic matter.

  2. Glutaraldehyde is sporicidal and not inactivated by organic matter.

  3. Formaldehyde is bactericidal, sporicidal and virucidal.

  4. Culture media used for diagnosis of EHEC O157:H7 is Sorbitol Macconkey media.

  5. Non-Typhoidal salmonella (NTS) transmission is most commonly associated with eggs, poultry and undercooked meat, it is common in immunocompromised individuals and resistance to fluoroquinolones has merged in it.

  6. Leptospirosis infection is acquired by direct contact with infected urine, mortality rate in it is 5-15% in severe cases and IV Penicillin is recommended for treatment of severe cases.

  7. Legionella may be transmitted through water aerosols.

  8. Listeria may be transmitted through refrigerated food.

  9. Leptospirosis may be transmitted through water contaminated with rat urine.

  10. Borrelia hermsii, Borrelia turicatae and Borrelia duttoni are associated with Tick borne relapsing fever.

  11. Most common mode of transmission of Pasteurella multocida is animal bites or scratches.

  12. ‘Maltese Cross’ is a characteristic feature of Babesia microti.

  13. Genital chlamydia infections are often asymptomatic, it can be cultures and inclusion conjunctivitis is caused by C. trachomatis serotypes D-K.

  14. Hepatitis C is most common indication for Liver transplantation.

  15. Enteroviruses are associated with aseptic meningitis, pleurodynia and herpangina.

  16. Parvovirus B19 is DNA virus, can cause severe anemia and can cause aplastic crisis.

  17. Dengue hemorrhagic fever is caused by reinfection with same serotype of Dengue virus.

  18. Primary receptor of HIV is CD4.

  19. Functions of CD4 includes immunogenic memory, activate macrophages and activate cytotoxic cells.

Forensic Medicine

  1. Privileged communication is made between Doctor and concerned authority.

  2. Disease which permanently alters the fingerprints is Leprosy.

  3. Casper’s dictum is used for Estimation o time since birth.

  4. Ante mortem abrasions can be confused with Ant bite marks.

  5. Extensive abrasions are found in road traffic accident case, these are due to Secondary injury.

  6. Stellate wound may be seen in Contact wound of bullet entry wounds.

  7. Commonest organ to be injured in primary blast injury is Lung.

  8. Hinge fracture of base of skull is called a ‘Motorcyclist’s fracture’.

  9. Heat rupture is characterized by Regular margins.

  10. Traumatic asphyxia may be caused by railway accidents, road traffic accidents and stampede in crowd.

PSM

  1. Vitamin A prophylaxis is an example of Specific protection.

  2. Criterias suggesting causality in non-communicable diseases includes strength of association, dose response relationship and specificity of association.

  3. Analytical studies includes Case control study, cohort study and ecological study.

  4. Incidence rates can be calculated by Cohort study.

  5. Longer duration of disease will cause an increase in prevalence of disease.

  6. Most suitable method for presenting frequency distribution of data gathered from continuous variables is Histogram.

  7. In standard distribution curve Mean = Median.

  8. In simple random sampling every element in the population has an equal probability of being included.

  9. In late expanding phase of demographic cycle, death rate declines more than birth rate.

  10. Crude birth rate is unaffected by age-distribution, indicator of fertility and excludes the stillbirths.

  11. Cut off weight for Indian reference man (kg) is 60.

  12. Baby friendly hospital initiative guidelines includes mothers and infant to be together for 24 hours a day, giving newborn infants no food or drink other than breast milk and encouraging breast feeding on demand.

  13. Latest WHO protocol for classification and measurement of disability is ICF.

  14. ‘STEPS’ is recommended by WHO as a method for surveillance o risk factors for noncommunicable diseases.

  15. Components of ‘IDEAS’ includes self-care, communication and understanding and performing in work.

  16. IMCI initiative was taken to prevent morbidity and mortality from malaria, malnutrition and otitis media.

  17. Targeted intervention in preventive strategy in spread of AIDS includes treating STDs, providing condoms and behaviour change communication.

  18. Chemoprophylaxis can be done for meningitis. Cholera and diphtheria.

  19. Aedes mosquitos are recurrent daytime biters, transmits dengue fever and breed in stagnant water.

  20. Q fever is transmitted by Ticks.

  21. Toxic shock syndrome is caused by infected measles vaccine.

  22. Blood transfusion carries maximum risk of transmission of HIV.

  23. After purification of water, coliforms must not be detectable in any 100 ml sample o drinking water, level of residual chlorine should be 0.5 mg/L and coliforms may be detected by multiple tube methods and indole production.

  24. During program planning ‘Goal’ term most appropriately defines desired end result that is not operationally measurable.

  25. During health planning, assessment of final outcome of a predetermined objective is termed as Evaluation.

Medicine

  1. 23-year-old asymptomatic woman with MCV – 70, ferritin – 100 g/L, Hb – 10 gm%. Most likely cause is Thalassemia trait.

  2. Conditions associated with PNH includes cerebral thrombosis, Budd Chiari syndrome and pancytopenia.

  3. 7-year-old girl with repeated episodes of bleeding into joints. APTT is prolonged and PT is normal. Most likely diagnosis is Von Willebrand disease.

  4. Coagulation factor VII deficiency is inherited as an autosomal recessive trait, can be managed by Fresh frozen plasma and has a shorter half-life in comparison to Hageman factor (XII).

  5. Lupus anticoagulant may present with an isolated prolongation of APTT, may present with recurrent abortions and may occur with minimal clinical manifestations.

  6. Acquired causes of hypercoagulability includes infection, inflammation,myeloproliferative disorder and prolonged surgery >1 hour.

  7. Causes of DVT includes OC pills, PNH and prolonged surgery.

  8. Elderly with headache, recurrent infections and multiple punched out lytic lesions on X-ray skull. Investigation for establishing diagnosis is Protein electrophoresis.

  9. ‘International prognostic index’ for lymphoma has prognostic factors which includes stage of disease, number of extralymphatic sites involved and LDH.

  10. ‘C’ wave in JVP is due to bulging of tricuspid valve into right atrium.

  11. Features of right sided heart failure includes pulsatile liver, increased JVP and positive hepatojugular reflex.

  12. Positive hepatojugular reflux is found in tricuspid regurgitation, right heart failure and pulmonic stenosis.

  13. Hepatomegaly with liver pulsation indicates Tricuspid regurgitation.

  14. Systolic thrill in left 2nd and 3rd intercostal space may be seen in subpulmonic VSD, pulmonary stenosis and Ebstein’s anomaly.

  15. Best predictor for future risk of cardiovascular events is hs CRP.

  16. Cardiovascular complications of HIV infection includes pericardial effusion, cardiac tamponade and cardiomyopathy.

  17. Iron deficiency anemia, diffuse alveolar hemorrhage and hemoptysis are seen in idiopathic pulmonary hemosiderosis.

  18. Patient with h/o episodic painful edema of face and larynx. Likely deficiency is C1 esterase inhibitor.

  19. Immediately after eating, a man develops swelling of face and lips, respiratory distress, intense pruritus, hypotension and feeling of impending doom. Most likely diagnosis is Anaphylaxis.

  20. Small cell carcinoma is chemosensitive tumor.

  21. Restless leg syndrome (RLS) is seen in CRF.

  22. 8-year-old girl admitted for dialysis has serum K+ of 7.5 meq/L. Fastest way to reduce hyperkalemia is infusion of insulin + glucose.

  23. Positive urinary anion gap helps to establish diagnosis of renal tubular acidosis.

  24. D-xylose test is used for assessment of mucosal function of GIT.

  25. Non-invasive diarrhea is caused by B. cereus.

  26. Features of secretory diarrhea includes stool volume >1 L/day, normal osmotic anion gap and it is painless.

  27. 7-year-old child with recurrent chest infections and exocrine pancreatic insufficiency is suspected of having cystic fibrosis sweat chloride levels have been observed between 40-60 mmol/L. Next test to support diagnosis is to demonstrate an abnormal nasal potential difference.

  28. Cystic fibrosis is autosomal recessive disorder, has predisposition to pulmonary infection with pseudomonas and cirrhosis is an established complication of CSF.

  29. Hepatomegaly is a feature of Von Gierke’s disease, Hurler’s disease and Niemann Pick disease.

  30. Increased aldosterone leads to hypernatremia, hypokalemia and hypertension.

  31. 29-year-old diabetic on oral hypoglycemics since 3 years has lost weight and never had DKA, his grandfather is diabetic and father non diabetic. Likely diagnosis is DM type II.

  32. If patient in above case has father and grandfather both diabetic then patient most probably has MODY.

  33. If a patient with severe hyperglycemia is given IV insulin, hypokalemia can occur.

  34. Most common cause of bilateral superior temporal quadrantanopia and galactorrhea in a lady is Pituitary macroadenoma.

  35. Hypercalcemia is associated with hyperparathyroidism, sarcoidosis and milk alkali syndrome.

  36. Endocrine causes of carpal tunnel syndrome includes DM, hypothyroidism and acromegaly.

  37. Hirsutism is caused by Cushing’s syndrome, hyperprolactinemia and acromegaly.

  38. Gold standard test for diagnosis of insulinoma is 72 hour fast test.

  39. Temporal arteritis is more common in females, seen in elderly women and can lead to sudden bilateral blindness.

  40. Recurrent bilateral hypopyon formation associated with thrombophlebitis is most consistent with Behcet’s syndrome.

  41. Patient with foreign body sensation in eye and swollen knee joint after a leisure trip. Most probable diagnosis is Reiter’s disease.

  42. False positive rheumatoid factor can be associated with HBsAg, VDRL and Coomb’s test.

  43. In JRA features seen includes fever, rheumatoid nodules and uveitis.

  44. Hemochromatosis is inherited as an autosomal recessive disorder.

  45. Spastic paraplegia is caused by Vitamin B deficiency, cervical spondylosis and Motor neuron disease.

  46. In Lambert Eaton myasthenic syndrome there is incremental response to repeated electrical stimulation.

  47. Retinal and cerebellar hemangioblastoma, pheochromocytoma and renal cell carcinoma are associated with Von Hippel Lindau syndrome.

  48. Triad of Tuberous sclerosis includes epilepsy, adenoma sebaceum and low intelligence.

  49. Neurofibromatosis is cutaneous neurofibromas, cataract and scoliosis.

  50. Systemic inflammatory response syndrome (SIRS) includes leucocytosis, hyperthermia and hypothermia.

  51. Selenium deficiency causes cardiomyopathy, calcium toxicity causes milk alkali syndrome and iodine toxicity causes acne like eruptions.

Surgery

  1. Man with blunt injury abdomen after RTA has BP 100/80 mm Hg and pulse rate 120 bpm. Airway established and respiration stabilized. Next best step in management is Blood for cross matching and IV fluids.

  2. Necrotizing fasciitis is infection of fascia and subcutaneous tissue, most commonly caused by Group A beta hemolytic streptococci and surgical debridement is mandatory in it.

  3. Triple assessment for CA breast includes clinical examination, mammography and FNAC.

  4. Moderately increased risk of invasive breast carcinoma is associated with atypical lobular hyperplasia.

  5. Well differentiated follicular carcinoma of thyroid can be best differentiated from a follicular adenoma by vascular invasion.

  6. Best treatment for a 2 cm thyroid nodule in a 50 year old man with FNAC revealing it to be a papillary carcinoma is near total thyroidectomy with modified neck dissection.

  7. Thoracic outlet stnd rome is primarily diagnosed by clinical evaluation.

  8. Popliteal artery pulsations are difficult to feel because it is not superficial and does not cross prominent bone.

  9. Intermittent claudication is defined as pain in muscle on exercise only.

  10. A patient with critical lower limb ischemia presents with rest pain and ischemic ulcers.

  11. Lumbar sympathectomy is of value in management of distal ischemia affecting skin of the toes.

  12. Sympathectomy is indicated in ischemic ulcers, intermittent claudication and acrocyanosis.

  13. Pseudoclaudication is caused by Lumbar canal stenosis.

  14. Best material for below inguinal arterial graft is saphenous vein graft (upside-down).

  15. Commonest part of subclavian artery to be affected by stenosis is 1st part.

  16. Most common site of rupture of abdominal aortic aneurysm is laterally into the left retroperitoneum.

  17. Most common cause of superficial thrombophlebitis is intravenous catheters/ infusion.

  18. ‘SEPS’ is a procedure used for veins.

  19. Non-progressive contraction of esophagus are Tertiary.

  20. Zenker’s diverticulum is acquired diverticula, lateral X-rays on barium swallow are often diagnostic and false diverticulum.

  21. Based on epidemiological studies, high fiber diet has been found to be most protective against carcinoma colon.

  22. Genes which may be involved in development of carcinoma of colon includes APC, Beta catenin, K-ras and Mismatch repair genes.

  23. Most important prognostic factor for colorectal carcinoma is Stage of lesion.

  24. parastomal hernia is most frequently seen with end colostomy.

  25. Risk factors for malignant change in an asymptomatic patient with a gallbladder polyp on USG includes age >60 years, rapid increase in size of polyp and associated gallstones.

  26. In pancreatic carcinoma, mutation in P53 gene is associated in 75% of cases, hereditary pancreatitis significantly increases the risk and 5 year survival after curative pancreaticoduodenectomy is 15-20%.

  27. Advantage of bladder drainage over enteric drainage after pancreatic transplantation is better monitoring of Amylase levels.

  28. Triple phosphate renal calculi are associated with previous infection.

  29. International Society of Pediatric Oncology (SIOP) is the post-chemotherapy based staging system in Wilms tumor.

  30. Concomitant chemotherapy is indicated in Stage III B Ca cervix, T2 N0 M0 anal cancer and T1 N2 M0 nasopharyngeal cancer.

  31. Smoking may be associated with Ca larynx, Ca nasopharynx, Ca bladder and Ca esophagus.

Pediatrics

  1. Most common fetal response to acute hypoxia is Bradycardia.

  2. Most sensitive indicator of depletion of intravascular volume in infants is Heart rate.

  3. varicella virus intrauterine infection is associated with Limb reduction defects and scarring of skin.

  4. Toxoplasmosis is likely to cause cerebral calcification and hydrocephalus is a newborn whose mother has history of taking spiramycin but was not compliant with therapy.

  5. Measles vaccine has maximum efficacy after a single dose.

  6. Inadequate nutrition is indicated by increased 1-4 year mortality rate, birth weight <2500 gm and decreased weight for height.

  7. For a child with AML with hyperleukocytosis, treatment includes IV fluids, Allopurinol and Alkalization.

  8. Prophylaxis of a neonate born to a HBsAg positive mother should include both vaccine and immunoglobulin.

  9. In childhood polycystic kidney disease pulmonary hypoplasia may be seen, renal cysts are present at birth and congenital hepatic fibrosis may be seen.

  10. 7-year-old girl with complaints of generalized swelling of body, grade 3 proteinuria and hyaline and fatty casts in urine, no hematuria. Then no IgG deposits or C3 deposition on renal biopsy will be seen.

  11. 5-year-old boy with precocious puberty and BP 130/80 mm Hg. Estimation of 11 deoxycortisol will help in diagnosis.

  12. Features of Juvenile idiopathic arthritis includes rheumatoid nodules, spikes of high fever and uveitis.

  13. neuroblastoma is most common extracranial solid tumor in childhood, >50% present with metastasis at time of diagnosis and often encase aorta and its branches at time of diagnosis.

  14. Increased acetylcholinesterase is a marker for neural tube defect.

Obstetrics and Gynaecology

  1. Creamy fishy odor is characteristically seen in Gadella.

  2. Causes of primary amenorrhea includes Kallmann’s syndrome, Turner’s syndrome and Rokitansky syndrome.

  3. Treatments for menorrhagia includes combined OC pills, progesterone and tranexamic acid.

  4. In obstructive azoospermia there is normal FSH and normal LH.

  5. Recommended non-surgical treatment of stress incontinence is pelvic floor muscle exercise.

  6. 35-year-old woman with P3G0 is observed to have CIN grade III on colposcopic biopsy. Initial management is LEEP.

  7. 45-year-old postmenopausal woman with vaginal bleeding, transvaginal USG reveals an endometrial thickness of 8 mm. Next step in management is Histopathological examination of curettage.

  8. Patient with ovarian cancer and planned for staging laparotomy. Surgical staging would involve peritoneal washings, peritoneal biopsy and omental resection.

  9. Serum LDH is tumor marker likely to be raised in a case of dysgerminoma.

  10. For DMPA failure rate is 0.3/HWY, it reduces menorrhagia and can be used in seizures.

  11. Most effective contraceptive methods recommended in lactating mothers is Progesterone only pill.

  12. Cardiac failure is a contraindication to laparoscopic sterilization.

  13. Mifepristone may be used for ectopic pregnancy, fibroids and molar pregnancy.

  14. Propylthiouracil can be safely used in pregnancy.

  15. Drugs which can be given to a mother with lupus after 35th week of gestation includes Chloroquine, Sulphadiazine/ Sulphasalazine and Prednisolone.

  16. Features seen in severe preeclampsia includes cerebral hemorrhage, pulmonary edema and acute renal failure.

  17. Minimum duration between onset of duration and death is seen in PPH.

  18. Primi with obstructed labour and neglected shoulder presentation. Mother shows signs of exhaustion and fetus is dead. Treatment of choice is Decapitation.

  19. Vaginal delivery may be recommended in 1st twin vertex, 2nd twin breech.

  20. Vaginal delivery is allowed in 1st twin vertex and 2nd twin breech, 1st twin extended breach and 2nd twin vertex and 1st twin mentoanterior and 2nd breach.

Ophthalmology

  1. Vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and Interleukin 8 (IL-8).

  2. Increased LDH in aqueous humor suggests a diagnosis of Retinoblastoma.

  3. Indocyanine green angiography (ICG angiography) is most useful in detecting Occult choroidal neovascularization (occult CNV).

  4. Features to differentiate central retinal venous occlusion (CRVP) from Ocular ischemic syndrome due to Carotid artery stenosis includes tortuous retinal vein, retinal artery pressure and ophthalmology.

  5. Treatment of advanced proliferative diabetic retinopathy with extensive vitreoretinal fibrosis and tractional retinal detachment involves Reattachment of detachment or torn retina, removal of epiretinal membrane and Vitrectomy.

  6. Juxtafoveal retinal telangiectasis are variant of Coat’s disease, associated with telengiectasias in macula and associated with structurally abnormal retinal vessels.

  7. Uveal effusion syndrome may be associated with Ciliochoroidal detachment, structural defect in Sclera and Nanophthalmos.

ENT

  1. Young man with an accident leading to loss of hearing in right ear, PTA shows Air-bone gap of 55 dB in right ear with normal cochlear reserve. Likely tympanometric finding is Ad type tympanogram.

  2. 38-year-old man with suspected labyrinthitis, positive Rinne’s test and positive fistula test. After refusal of treatment, patient returns to emergency after 2 weeks anc complaining of deafness in affected ear, fistula test negative. Likely expected finding on repeating Rinne’s test is false negative Rinne’s test.

  3. Most potential route for transmission of Meningitis from CNS to inner ear is Cochlear aqueduct.

  4. Trotter’s triad includes Mandibular neuralgia, deafness and palatal palsy.

  5. Laryngeal pseudosulcus is seen secondary to Laryngopharyngeal reflux.

  6. Recurrent laryngeal papillomatosis is caused by Human papillomavirus (HPV), HPV6 and HPV11 are most commonly implicated and transmission to neonate occurs through contact with mother during vaginal delivery.

  7. Topical Mitomycin C is used to aid treatment of Laryngotracheal stenosis.

Orthopaedics

  1. Synovial fluid follows non-newtonian fluid kinetics, contains hyaluronic acid and Viscosity is variable.

  2. In a patient with gouty arthritis, synovial fluid aspiration will show Monosodium urate crystals.

  3. Recommended treatment for Chronic low back pain includes NSAIDs, Exercises and Epidural steroid injection.

  4. Recurrent dislocations are seen in Hip, shoulder and patella.

  5. Primary pathology in Athletic pubalgia is Abdominal muscle strain.

  6. Most common cause of death after Total hip replacement is Thromboembolism.

  7. High tibial osteotomy is indicated in unicompartmental osteoarthritis, performed through cancellous bone and recurrence is a long term complication.

  8. Myodesis is employed in amputations for trauma, tumor and children.

  9. Nerves involved in entrapment neuropathy includes median nerve, ulnar nerve and lateral cutaneous nerve of thigh.

  10. Muscles most commonly affected by congenital absence is Pectoralis major.

  11. ‘T-10 protocol’ for treatment of osteosarcoma includes high dose methotrexate, Bleomycin, Cyclophosphamide, Doxorubicin (BCD) and Vincristine.

  12. Milkman’s fracture is a type of Pseudofracture.

Skin

  1. Incontinentia pigmenti is X-linked dominant, primary skin abnormality and includes avascularity of peripheral retina.

  2. Scarring alopecia is seen in Lichen planus.

  3. Primary cutaneous disease includes Psoriasis, Lichen planus and Ichthyosis.

  4. Lichen scrofulosorum is characterized by involvement of sweat gland and hair follicles with non-caseating epithelioid granulomas.

  5. A child with fever, multiple tender erythematous skin lesions and neutrophilic and histiocytic infiltration in the dermis. Diagnosis is Sweet syndrome.

Anaesthesia

  1. Sodium bicarbonate when given with local anaesthetic increases speed and quality of anaesthetic.

  2. Anaesthetic drug injected for paravertebral block is least likely to diffuse to subarachnoid space.

  3. Signs of successful stellate ganglion block includes nasal stuffiness, guttman sign and Horner’s syndrome but does not include bradycardia.

Radiology

  1. Focal and diffuse thickening of gallbladder wall with high amplitude reflections and ‘Comet tail’ artifacts in USG suggests the diagnosis of Adenomyosis.

  2. CT features of Adrenal adenoma includes low attenuation, homogenous density and well defined borders and calcification is rare.

  3. Sensitivity of mammography is low in young women because young breast have dense tissue.

  4. Most sensitive investigation for DISC of breast is Mammography.

  5. MRI features of Mesial temporal sclerosis includes atrophy of mammillary body, atrophy of fornix and atrophy of hippocampus.

  6. Pruning of pulmonary arteries is seen in Pulmonary hypertension.

  7. In ossified posterior longitudinal ligament (OPLL) gradient echo MR sequence may overestimate the canal stenosis, MRI is best for diagnosis and low signal intensity on all MR sequences.

  8. Test of choice for Reversible myocardial ischemia is Thallium scan.

  9. In a Down’s syndrome patient posted for surgery, the necessary pre-operative investigation to be done is Echocardiography.

  10. Amifostine protects Salivary glands, Kidneys and GIT.

  11. Hypoechogenicity, nonhomologous and microcalcification is suggestive of malignancy.

Psychiatry

  1. Patients suffering from Mental retardation as per ICD/DSm criteria are eligible for disability benefit as per National Trust Act.

  2. Lithium is used in treatment of Major depression, vascular headache and neutropenia.

  3. Modafinil is approved by FDA for treatment of Obstructive sleep apnea syndrome (OSAS), shift work syndrome (SWS) and Narcolepsy.

To download eBook or for further discussion visit our forum book section here.

To download from Google Play Books click here.